Essential, or primary, hypertension is detectable in childhood. Due to the rising rates of childhood obesity, the expression of essential hypertension in childhood is increasing. Despite this trend, the possibility of secondary hypertension should be considered in a child with documented hypertension. Children and adolescents with suspected secondary hypertension may require a more extensive evaluation compared with those expressing characteristics of essential hypertension. Whether the hypertension is determined to be secondary or essential, these children require careful monitoring, interventions to control the blood pressure, and long-term follow-up. Considering the long-term morbidity and mortality associated with essential hypertension, interventions, including preventive interventions, that focus on blood pressure control beginning in the young are an important component of healthcare for children and adolescents.